Clinical management and outcome of refractory asthma in the UK from the British Thoracic Society Difficult Asthma Registry

Abstract

Refractory asthma represents a significant unmet clinical need. Data from a national online registry audited clinical outcome in 349 adults with refractory asthma from four UK specialist centres in the British Thoracic Society Difficult Asthma Network. At follow-up, lung function improved, with a reduction in important healthcare outcomes, specifically hospital admission, unscheduled healthcare visits and rescue courses of oral steroids. The most frequent therapeutic intervention was maintenance oral corticosteroids and most steroid sparing agents (apart from omalizumab) demonstrated minimal steroid sparing benefit. A significant unmet clinical need remains in this group, specifically a requirement for therapies which reduce systemic steroid exposure.

Conflict of interest statement

Competing interests: Ms Sweeney is supported by HSC R&D (NI) and GlaxoSmithKline (PhD studentship funding). Professor Brightling is supported by a Wellcome Senior Clinical Fellowship and has received consultancy fees and or research funding from GlaxoSmithKline, AZ, MedImmune, Amgen, Novartis, Chiesi, BI and Roche. Dr Menzies-Gow has attended advisory boards for Novartis and Genentech. He has received sponsorship to attend international meetings from GlaxoSmithKline, Novartis and Boeringer Ingelheim. He has received lecture fees from Novartis, GlaxoSmithKline, Astra Zeneca and Chiesi. Dr Niven has received an unrestricted grant of £10 000 from Novartis in 2010 towards development of clinical services at the University Hospital of South Manchester. In addition he has lectured in the field of severe allergic asthma at Novartis-sponsored meetings receiving honoraria in total not exceeding £5000 in the last 3 years. Dr Niven has also performed lecturing at pharmaceutically sponsored meetings for the following pharmaceutical companies in the last 3 years: Astra Zeneca (<£1000), GlaxoSmithKline (<£5000) and Chiesi (<£1000). He has sat on advisory boards for the following companies in the last 3 years: Vectura, Novartis, GlaxoSmithKline, receiving reimbursement not exceeding £1000. He has received sponsorship support to attend international academic meetings. Dr Niven (or any members of his family) has no shares or any percuniary interest in any pharmaceutical industry and has nothing to gain financially from the publication of this paper. Dr C Patterson's spouse holds shares in GlaxoSmithKline. Professor Heaney has received grant funding from Genentech, and GlaxoSmithKline, has taken part in Advisory Boards and given lectures at meetings supported by GlaxoSmithKline, Merck Sharpe & Dohme, Nycomed, Novartis and Astra Zeneca. He has received support funding to attend International Respiratory meetings (Astra Zeneca, Chiesi, Novartis, Teva and GlaxoSmithKline) and has taken part in asthma clinical trials (GSK and Genentech) for which his Institution was remunerated. None of these activities have any direct relationship to the content of this manuscript.